Cannabis & Pain

Cannabis Pain Article

Pain is an experience all humans share. From physical, mental and emotional pain, to whether its acute pain, such as when you cut your finger or stub your toe, or chronic pain, like conditions such as fibromyalgia, everyone will experience pain at some point in their life. Around 20% of the world’s population lives in chronic pain, and in the western conventional medical setting, the options for pain management are mostly narcotics, steroids, and physical therapy, none of which are totally effective or safe for everyone.

In the last several years, the medical community has had to take a hard look at the negative impact opioid narcotics have on society, and according to the Center For Disease Control (CDC) 68% of the more than 70,000 drug overdoses involved opioid use, and around 130 people die each day from an opioid overdose. This current situation has been deemed the opioid crisis and has forced the healthcare community to look at better solutions for managing pain. Look no further than cannabis!

Chronic pain is defined as persistent pain that lasts for longer than three months. While all people experience pain, how it is perceived and treated varies tremendously across cultures. Regardless of peoples individual perceptions of pain, it is something that can greatly negatively impact a person ability to work, maintain social and romantic relationships and live to their optimal potential.

The International Association for the Study of Pain (IASP) defines pain as. “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” The accepted and most used understanding of pain is referred to as the Gate theory, and it describes pain response as essentially a system of keyholes that can be unlocked by various chemical mediators, so if we can block those keyholes, or divert those chemicals somehow, we can circumvent a pain response.

So pain management is essentially about finding ways to distract the pain, and rarely is focused on healing the root of the pain. And that’s fine for some conditions, that without a more invasive intervention, will not heal anyway, but there are more effective ways of managing pain that also help reset the entire system, namely the endocannabinoid system, which is major component in pain processing in the nervous system.

About 30 years ago, researchers discovered the endocannaboid system, a chemically medicated receptor system in the nervous system in humans that researchers were shocked to find produce similar cannabinoids as those found in the cannabis plant. These are called endogenous cannabinoids, while the ones in cannabis are called exogenous cannabinoids.

This receptor system plays a major role in the chemical processes of all systems in the body, and the exogenous cannabinoids in cannabis fit perfectly into the receptors of this system in human bodies. This alone is great indication that humans have likely coevolved with this plant for thousands of years.

Pain researchers mostly deal with two types of pain, neuropathic and nociceptive. Nociceptive pain relies on a signal receptor system, while neuropathic pain implies damage to the central or peripheral nervous system. Diabetics and people in cancer treatment who experience numbness, tingling, pain, loss of sensation in hands, feet, and limbs are experiencing neuropathic pain. Cutting your finger with a knife is an example of nociceptive pain.

Pharmacological pain solutions have proven mostly ineffective for managing both types of pain, especially with the risk of abuse and overdose associated with narcotic pain relievers.

Cannabis has been used for pain relief in cultures around the world for thousands of years. There is documented use of cannabis in one of the oldest known medical texts that is still used by Traditional Chinese Medical practitioners today, the Shen Nong Ben Cao Jing, written during the Han dynasty in China sometime in between 206 BCE and 220 AD.

In the Shen Nong, cannabis was classified as a 1st degree drug, meaning that is not poisonous and can be used daily without significant long term side effects. Anyone can google medical cannabis today and find thousands of articles, videos, testimonials and other materials about the use of medical cannabis for pain relief. The current classification of cannabis as a Schedule 1 substance in the US implies that it has no medical use, but research, traditional and anecdotal evidence prove otherwise, and millions of people worldwide use cannabis for pain relief daily. This classification has unfortunately inhibited the amount of research that’s been conducted about cannabis and its efficacy here in the US.

There are a number of ways to, reducing inflammation pathways and analgesia, which blocks or redirects pain signals is one of the most widely used methods. Tetrahydorcanabinol –9 (THC) is the most well-known cannabinoid, and the one responsible for the primary psychoactive effects of cannabis. This compound must be decarboxyalated to produce its psychoactive effects, which is why cannabis is smoked and if its ingested it must be heated or processed and converted into the acidic form of the molecule to produce psychoactivity.

Both acute and chronic pain have proven to be effectively reduced with the use of THC, but the psychoactive effects make its use limited for a vast amount of the population. CBD has been found to be mostly effective for chronic pain, as opposed to acute, but the other compounds, particularly the almost 500 other cannabinoids, and the hundreds of terpenes, also called aromatics, all play an important role in the psychoactive, pain relieving and other effects of cannabis.

Some of these compounds actually mediate the actions of THC, CBD and other cannabinoids, this is referedd to as “synergy” and why it makes studying plant medicine of any kind difficult within the current pharmacological model used in medical research. This is why whole plant extracts have become the preferred use for many people.

GW pharmaceuticals in Canada has developed a whole plant 1:1 THC:CBD extract that’s prescribed to patients with Multiple Sclerosis and those with cancer who have opioid resistant pain. The effectiveness of this particular product lends to the idea that whole plant products are superior in their physiological actions, due to the synergy of the hundreds of compounds in the plant.

When individual compounds are isolated and concentrated for medical use, they have a much different effect in the body than when whole plant products are used. There is evidence that some of the other cannabinoids as well as the terpenes, which are the aromatic compounds that give the plants their odor and taste, are also involved in meditating the medicinal benefits of cannabis, so this is another reason using isolated THC or CBD products may not be as effective as whole plant.

Many of the these aromatic compounds are found in other plants and already have a good deal of research about their pharmacological activity, such as pinene and myrcene. A lot of people are apprehensive of cannabis use due to the psychoactive effects, but the THC must be heated or have a reaction of some sort to change it into its psychoactive form. So it is possible to use THC containing cannabis and not get the psychoactive effect, if one makes an unheated preparation with it, and does not heat it, only about 1-2% of the THC will have this reaction, and most people will not experience any psychoactivity.

Regular cannabis user may not have the same pain relieving effects as those who are not long term regular users already, so that is something else to keep in mind. Ingesting cannabis as food or liquid may prove to be more effective for pain relief for many people, and people may have to try several different types of cannabis products before they find the one that works for them.

In general, cannabis is safe to use, and produces little side effects, particularly when not using the psychoactive products. Consult with your local cannabis medical experts to help find the cannabis that could help you live a life free of pain.

References

Drug Slang Code Words. (n.d.). Retrieved January 30, 2019, from https://www.dea.gov/documents/2017/05/01/drug-slang-code-words

IASP Terminology - IASP. (n.d.). Retrieved January 30, 2019, from https://www.iasp-pain.org/terminology?navItemNumber=576#Pain

Understanding the Epidemic | Drug Overdose | CDC Injury Center. (n.d.). Retrieved January 30, 2019, from https://www.cdc.gov/drugoverdose/epidemic/index.html

Aviram, J., Aviram, J., & Samuelly-Leichtag, G. (n.d.). Systematic Review Efficacy of Cannabis-Based Medicines for Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Retrieved from www.painphysicianjournal.com

Clarke, R., & Merlin, M. (2013). Cannabis Evolution and Ethnobotany. Berkeley and Los Angeles, CA.

Parker, L. (2017). Cannabinoids and the Brain. Cambridge, MA

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